Just another day on the wards ... where they try to turn us from caregivers into heartless billing machines. We treat the computer, not humans. Are we all just being conditioned to take it? Read the transcript below: ZdoggMD:"Welcome to Jurassic Park!" I don't know why you guys have to fog every single scene we do. Anyways, I wanted to just do a quick thing here because I just was rounding at the hospital today with the team -- fantastic new medical students and residents -- a real team all trying to do the right thing for patients. This is what I saw in rounds today. I saw people trying to figure out how to get data into and out of Epic for a ... I don't know; 50% of the rounds was, "Wait, how do I open it?" "Wait, your notes are already open and that means I can't do a billing code. Then you're doing the ..." 50%. I asked the residents how much of your day is actually spent in direct patient care and how much is treating the computer and the administrative tasks you have to do? They didn't disagree about this number. They said, "Oh, it's 90% computer and 10% patient care." OK. It seemed unbelievable to me until I was actually rounding. It is brutal out there. I am going to tell you this not just as an old fart, which I am. Thank you very much. "Welcome to Jurassic Park!" That movie, I was an adult for that movie. That's how old I am, all right? I tell you this because I have straddled both worlds. I lived in a paper world, a transitional world, and a world where we're on Epic or whatever ... screw it. Epic. OK? They are the 800-pound gorilla in the room and they SUCK to the tunes of billions of dollars, hobbling enterprises with this cost to give us a system that is so complicated and so obnoxious to use. "Oh, but it's so robust. You can do this. Think of the billing you can do." Can you do patient care? No. When in the old days of paper, what used to happen is you would write something very simple. "The patient has this. She comes in today. We spent a lot of time together. This is my impression." There is your note. Then when you want to do something, you say, "Please give an insulin drip titrating to glucose of this." The team came together -- the pharmacist, the doctor, and the nurse -- and they made it happen. Now, the residents and the attending physicians are sitting there going, "How do I make this insulin drip order set customized to this particular ... ?" But this, click box now ... and they spend about 20 minutes figuring this out. They hit send, sign the order, and then they get a call from the pharmacist and the nurse to clarify what was in Epic. That is not the way to do medicine. OK? This is dumb. We're in the 21st-century. Fix the technology. I'm not saying go ... look. I'll tell you the best time in my career was when I had read-only access at Stanford so I could get labs, imaging, and that stuff inbound, but we were paper on the outbound. I could be like, "Just do this. Here's what I think." Or tell a colleague like the consultants, "This is my concern. Can you please help?" Now, we're hiding in electronic silos and messaging each other. No one talks to each other. Then, I'm working at a hospital where it's all about the social determinants of health. It's homelessness, substance abuse, and poverty. OK? I did not see a patient today who is in any kind of a privileged position. These are people who have had all the decks stacked against them. But in this country, of course, we medicalize our social problems. We are all sitting there going, "How do we send a homeless guy home who's say ..." and I can't give away too much because of HIPAA. But who's got a lot of problems, there's no way he or she is going to do well on the street and yet we have no medical reason to keep this person in the hospital? All the powers are pushing us to get them back out to the street, yet everybody in that fricken room actually cares about this person not having something bad happened to them. But we're powerless. "Call Social Work." "They can't do anything." "Call a case manager." "They can't do anything." What about the shelters? "He's had this and that, and this or that happened at the shelter." Now, what do you do? "Discharge to Street." That's what they tell you to do. Did we do that? No, because we're not horrible and evil people. We're trying to hold on to the shred of dignity we have and this caring that brought us into the field in the first place. Combine that disaster in this country of medicalizing social problems with this technocracy that's destroying our ability to actually look patients in the eye. Then you wonder why 60% of physicians won't recommend the career to their kids? All right? That was my morning. You know what the strange thing is? I'm fired up and inspired. That's what I told the residents and the medical students at the end. I said, "Because you know what? If this doesn't piss you off, if this doesn't get you mad to actually stand up and be a part of this movement where we're all trying to change this -- better technology that enables human relationships and being paid well to do good for patients -- without all the bureaucratic nonsense, shrink the technocracy. Just do the right thing for patients, get compensated to do that, and start to address the social issues in this country. If we can do that, we transform medicine, and it's on us. You either do that or go become an investment banker and make cash for the sake of making cash because it's going to be equally morally invalid what you're doing. OK?" The call to action is this: share this rant. If you want to go deeper, join our supporter tribe. That's where we have conversations like this littered with F-bombs every single day. Do your part to have a voice, OK? Leave a comment and maybe join our discussion groups because all healthcare is local, and it's going to happen on the local level. All right, snitches. I'm out! I'm Jurassic Park, Logan. The next time, more fog. Not enough fog. This post originally appeared on ZDoggMD. Source
